IEEE Systems, Man and Cybernetics Magazine - October 2020 - 57

the requirements that are important to the therapists for
monitoring and assessing the patients.
Patients' Requirements
A key requirement is the inducement of neuroplasticity,
i.e., the natural capability of our nervous system to
adapt its structure and connections in response to stimuli, such as learning activities or physical rehabilitation
[19], [20]. To promote neuroplasticity, physical rehabilitation therapies need to provide exercises that are specifically designed to regain a skill (functional exercises)
as well as allow for many repetitions as part of intensive
sessions [6], [20].
As part of their natural adaptation to their impairment,
patients will develop compensatory strategies to achieve
their functional objectives. Nevertheless, compensations
might result in maladaptive neuroplasticity that could hinder
the generality of the rehabilitation process. As such, patients
should try to avoid compensating as much as possible.
The appropriate feedback should constantly be provided by the therapist so that the patient will know that he/
she is correctly executing each phase of the exercises. In
addition, if the patient is not correctly performing the exercises, feedback is provided to guide him/her toward the
appropriate actions.
A key component of the therapy is to keep the
patients motivated and engaged. To meet this requirement, most of the in-hospital therapeutic exercises are
presented as ludic activities. A computer-based system
should be appealing and fun to use to ensure that the
patient engages with it.
During the in-hospital sessions, therapists constantly
assess the capabilities of the patients and adapt the exercises to their current performance. Different factors, like tiredness, will negatively affect the performance of the patient
during a session. Hence, according to the actual capabilities of the patient, the therapists will change the parameters of the task to make it challenging but not impossible.

Therapists' Requirements
One of the main advantages of in-hospital face-to-face
rehabilitation therapy sessions is that the therapists can
constantly monitor and assess the patients. Computerbased systems can capture different types of data to
assess patients' performance. By using several sensors
(e.g., brain and body wearables [21]), the system can capture more data than a single therapist can, which in turn
can help better assess the patient. Nevertheless, care must
be taken before using electroencephalography sensors
because these devices are designed for reading the activity
of healthy brains, which can be different from that of
patients with neurological abnormalities, as is the case of
poststroke patients [22].
Computer-based systems can adapt themselves to the
patient's performance by employing adaptive algorithms to
constantly change or tailor the difficulty of the tasks. Nevertheless, some features of the system might not be useful
or appropriate for certain patients. Because the therapist
is the expert, he/she should be able to modify the system's
parameters when necessary.
Computer-based systems can capture a large amount of
data for analysis; however, the data in most cases (especially numeric data) are meaningless to the therapist. Data
should be interpreted and presented as easy-to-understand
information, such as graphics.
Computer-based systems must establish a communication channel between therapists and patients, which
allows for the exchange of information to better adapt the
therapy sessions. In the case of risk situations, the system
should provide alerts to the patients and the therapists so
that the latter can assist or, if necessary, stop the session.
System Architecture
Based on the aforementioned requirements, a system
architecture was designed to meet the identified needs
(Figure 1). It is divided into two interconnected components: the therapist's and the patient's interface.

Gamified In-Home Neuromotor Rehabilitation System
Patient

Natural User
Interface

Game-Based
Rehabilitation

Therapist

Data Capture

Communication

Adaptation

Data Storage

Communication

Knowledge
Extraction and
Data Analytics

User
Interface

Figure 1. The system architecture.

O c tob e r 2020

IEEE SYSTEMS, MAN, & CYBERNETICS MAGAZINE

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IEEE Systems, Man and Cybernetics Magazine - October 2020

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